Job losses and fudged figures
The Homerton hospital in East London no longer has a children’s asthma clinic. The senior specialist nurse with decades of experience and who has a driving interest in the subject, the children and their families, has been pushed to resign. This follows a decision to ‘disestablish’ her post in a money-saving exercise presented as a fait accompli by senior clinicians and managers. The loss of such a nurse will go down in the column ‘natural wastage’.
In April, as its conference opened, a Royal College of Nursing (RCN) study reported that a combination of redundancies, recruitment freezes and post closures had led to a reduction of 22,300 nurses over the previous 18 months. A poll of 807 specialist nurses interviewed for the study found that one in five were at risk of redundancy and half knew of cuts in their specialist area. This came just as the government announced that the NHS was to finish the financial year with a £13 million surplus, despite one in three hospitals and primary care trusts predicting deficits.
In response to the RCN, the Department of Health claimed that their figures represented the natural turnover of staff in any organisation and that the number of compulsory redundancies was 1,446 of which only 303 were doctors or nurses. Yet the latest figures from the NHS Information Centre show that 17,000 posts have been lost in the twelve months to July, and even if ‘only’ 1,500 are compulsory redundancies there are many who have gone through voluntary redundancy or resigned because they feel they have no other option. One expression of the large number of job losses in the NHS is the £320 million cost of redundancies and early retirements that followed the reorganisation of strategic health authorities and primary care trusts in April this year.
More redundancies
In mid-July, the North Yorkshire Trust, which runs Scarborough General and Bridlington District hospitals and which covers one of the largest geographical areas in England, announced that it will cut 600 jobs, equivalent to one third of the workforce, to make an annual saving of £10 million. Desperate and pathetic words from the chief executive included an unbelievable claim that such cuts would not affect the A&E department.
Meanwhile the treasury has reclaimed £2 billion of unspent NHS capital only £4.2 billion of the £6.2 billion 2008 budget for NHS capital expenditure in England will be used. Ministers say that this money will be restored to next year’s budget, but since spending plans have not been published, proving it has been carried over will be very difficult.
Unelected health minister’s plan for London
‘The day of the district general hospital seeking to provide all services to a high enough standard are over’ says Sir Ara Darzi, professor of surgery at Imperial College London who has spent the last eight months working on a review of health provision in London and has come up with a ten year plan for reorganising it. The London Strategic Health Authority (SHA) commissioned his report last September; it is the third one of its nature in the last 15 years. As a reward for this effort, Gordon Brown appointed him to a ministerial post in the Department of Health in July.
London has 93 hospital sites, over 1,400 mental health and community facilities and al–most 1,600 GP practices. The assets are worth tens of billions of pounds. Darzi’s vision is to shift work from hospitals into polyclinics and urgent care centres to cater for people closer to home and to have up to 12 specialist hospitals, between eight and 16 major acute hospitals (which would serve 500,000 to one million people each) and a handful of academic health science centres created by integrating top hospitals with universities’ biomedical research centres. 150 polyclinics, with long opening hours, would provide community-based care at levels be–tween GP practices and district general hospitals, including pharmacy, dentistry, social and mental health, x-ray and ultrasound services, blood tests and minor surgery.
The London Health Emer–gency pressure group predicts that there are nine major acute hospitals which will face closure or downgrading in the coming period. These include Chase Farm hospital in Enfield, Epsom and St Helier, Queen Mary’s Sidcup, Central Middlesex in Park Royal, King George’s in Ilford, Hammer–smith Hospital, one north London hospital, possibly the Royal Free, and one west London hospital, possibly West Middlesex. Although Darzi says that his review is clinician-led, the London SHA will have a much harder-nosed approach. Hence Queen Mary’s Sidcup is under threat because the NHS in outer south east London has an annual deficit of £100m, and the three adjacent hospitals (Bromley, Queen Elizabeth and Lewi–sham) all have very large PFI commitments which the NHS has to honour. A complex reorganisation of clinical services will see some patients being treated at two or even three different sites, and will undoubtedly require substantial job losses in order to make the necessary savings.
Whatever Darzi claims, im–provement in health care provision and access for all will not come about by reducing staff numbers, by pushing out the most experienced clinicians from all areas of health care work, or by increasing the use of the private sector and further breaking up the system.
FRFI 198 August / September 2007
